Complaint

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CITIZEN COMPLAINT FORM

Please fill out the form below as accurately and completely as possible. You do not have to leave identifying information such as your name and phone number, but if you do not leave that information we will not be able to follow up with you if we have additional questions once an investigation is started.

First Name

Middle Name

Last Name

Suffix

Gender

Male

Female

Race

Caucasian

African American

Asian & Pacific Islander

American Indian or Inuit

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

Date of Birth

MM/DD/YYYY

Primary Phone Number

999-999-9999

Secondary Phone Number

999-999-9999

Address1

Address2

City

State

Zip

E-mail address (primary)

E-mail address (secondary)

Employer

Work address

Work phone number

Date & Time of Incident*

Date & Time of Incident

Date & Time of Incident

Approximate date and time if exact time is unknown

Location of Incident*

Address or approximate location

Type of Incident*

Number of Officers*

Enforcement Action*

Nature of Complaint*

Rude conduct toward me or a third party

Use of foul or inappropriate language

Unprofessional conduct toward me or a third party

Vehicle operation not in compliance with traffic laws

I believe the situation I was involved in was handled poorly or unfairly

Other, please see narrative

Please select the option or options that best describes the nature of your complaint. You may select more than one option.

Name of Officer

Physical description

Name of Officer

Physical description

Name of Officer

Physical description

Name and Contact Information of any witnesses

Please fill out the name, approximate age and phone number of any witness to the events.

Description of incident*

As clearly and concisely as possible, please describe the incident in question.